A lack of vaginal moisture may have a significant impact on a woman’s sex life. Sex does not have to hurt. Fortunately, there are many available options to provide the vagina with moisture and make sex pleasurable.

Here are eight tips to help solve the problem of vaginal dryness. 

1. Water-based sexual lubricants

Sexual lubricants reduce friction. Lubricants enhance the experience and eliminate painful chafing and burning. 

The application of sexual lubricant as a part of foreplay is a simple trick for many women to improve sexual pleasure. Lube may be applied directly to the vagina, clitoris, or penis before penetration.

Not all lubricants are the same. Most lubricants available at a local pharmacy are water-based. Water-based lubricants are the safest choice to prevent sexually transmitted infections. They do not break down latex in condoms or sex toys. Water-based lubricants are ideal for those with sensitive skin or those prone to vaginal irritation. 

Water-based lubricants do not leave stains on sheets and are easy to clean in the laundry. 

Popular brands include Astroglide and KY. 

On the downside, water-based lubricants dry out quickly. Rapid drying may require reapplication for longer sexual sessions. For those suffering from chronic vaginal dryness or inadequate natural lubrication during sex, they may be insufficient. Water-based lubricants are often suboptimal for postmenopausal women.  

2. Silicone-based sexual lubricants

Silicone-based lubricants stay slippery longer, avoiding the frustration of rapid drying and reapplication messiness. This type of lubricant does not evaporate when exposed to air and provides a wet sensation for longer sexual sessions. Since they are not water-based, silicone lubes may be used in the shower or bathtub.

One popular brand is Platinum Wet. This Paraben and Glycerin free product reduces the risk of chemical irritation. Penchant Premium is another hypoallergic option ideal for those with sensitive skin. 

Silicone-based lubricants may be more effective and pleasurable for monogamous couples at low risk for sexually transmitted infections. 

Non-water-based lubricants have downsides too. They are messy. Soap and water must be used to remove them, and they will also stain sheets. 

Silicone-based lubricants will break down latex condoms or latex in sex toys.

3. Foreplay 

We can not underestimate the value of foreplay for those with chronic vaginal dryness. Foreplay gets the juices flowing by increasing sexual arousal. Blood flow to genitals increases, causing the vagina, labia, and clitoris to swell. 
Better stimulation leads to more natural lubrication and an increase in vaginal elasticity. The vagina then secretes natural lubrication, which increases pleasure and reduces pain. 

For those with chronic vaginal dryness, communicating sexual needs and desires to your partner is critical. Sexual partners may be unaware of the physiological changes and not know what to do. Providing feedback allows the partner to learn how best to meet your needs.

4. Vaginal Moisturizers

Multiple products over-the-counter products are available to help increase vaginal moisture. The basic idea is to prevent dryness and improve the vaginal ph balance. These products do not treat the underlying cause of vaginal dryness. They are useful for day to day use to alleviate discomfort and improve vaginal moisture.

Those will sensitive skin may benefit from avoiding products containing parabens, glycerin, or propylene glycol. These additives may cause skin irritation. 

Popular products include Replens and Luvena. 

5. Vaginal Estrogen

Estrogen is one of the most important female hormones. A decrease in the production of estrogen by the ovaries triggers physiological changes in the vagina. The vaginal tissues thin out, and lubrication decreases. 

Breastfeeding, certain medications, and menopause all cause estrogen deficiency.

Prescription estrogen medication can be placed directly into the vagina to offset the deficiency. Low dose Estrogen applied directly to the vagina bulks up vaginal cells and increases blood flow. Restoring vaginal health allows cells to produce more moisture. Natural lubrication improves, and the more elastic vaginal walls reduce resistance to trauma during penetration.

Vaginal estrogen comes in a variety of forms from creams, rings, and vaginal tablets. All require a prescription and evaluation by a health provider before use. 

6. DHEA supplements 

The DHEA hormone is a highly effective alternative to estrogen therapy. Before menopause, DHEA levels are high. As the ovaries stop functioning, DHEA levels fall. DHEA supplements can be placed into the vagina to restore vaginal health, reduce intercourse pain, and improve vaginal dryness. 

Only one medication is commercially available. Prasterone, sold under the brand name Intrarosa, is a plant-derived form of DHEA. Prasterone is inserted into the vagina once a day through an easy to use applicator. DHEA converts into estrogen targeting the underlying cause of dryness. It is FDA indicated for painful intercourse.

Prasterone requires a prescription and monitoring by a health provider.

7. Selective Estrogen Receptor Modulators 

Another alternative to estrogen therapy is a class of drugs called SERMS (Selective Estrogen receptor modulators). These medications act directly on the hormone receptors. Direct targeting of the vaginal tissue increases the thickness of the superficial and parabasal vaginal cells.

Like estrogen and DHEA therapy, the restored health of the vaginal cells improves the natural ability to produce moisture and lubrication. 

Ospemifene is the only FDA approved oral drug for vaginal dryness and painful intercourse.

Ospemifene requires a prescription and monitoring by a health provider.

8. Topical Sildenafil 

Sildenafil is a popular medication used to treat erectile dysfunction in men by increasing blood flow to the penis. Some women benefit from the topical application of Sildenafil. 

A pea-size amount of compounded Sildenafil cream is applied directly to the clitoris before intercourse. Sildenafil cream increases blood flow to the clitoris. For some women, the increased blood flow triggers more natural lubrication, improves pleasure, and helps to achieve orgasm. 

Sildenafil requires a prescription and monitoring by a health provider for this off label use.

Vaginal dryness is a problem you don’t have to ignore

Vaginal dryness is a common symptom among women. Painful intercourse and vaginal discomfort are not problems to be tolerated. These options can help one restore vaginal health and enhance the sexual experience. 

The post 8 Tips to Solve Vaginal Dryness and Overcome Painful Intercourse appeared first on Medika Life.

There are many conditions that can cause vaginal pain during intercourse; one is vaginal atrophy. This condition often stops women from taking part in lovemaking, let alone enjoying it. The worry is that penetration will hurt them, and with that worry, their sex drive falls flat on the floor. Although the condition can affect women of any age, it is mainly after menopause sets in it is experienced.

Vaginal atrophy can seriously affect relationships, and yet very few women talk about their experiences. Some are embarrassed, while others don’t know where to go for help, accepting that it is a part of life and that nothing can be done about it¹. But atrophy is a serious condition as if it goes untreated; it can cause the vaginal walls to close up. Regular intercourse is necessary for healthy vaginal walls, though it isn’t a guarantee that regular lovemaking will stop vaginal atrophy.

What is vaginal atrophy?

Vaginal atrophy is when estrogen levels decrease, and the vaginal tissue becomes thinner, drier, not as elastic, and more fragile. The symptoms of vaginal atrophy includes²:

• Vaginal dryness
• Vaginal burning
• Vaginal discharge
• Vaginal inflammation
• Genital itching
• Light bleeding after intercourse
• Discomfort with intercourse
• Shortening and tightening of the vaginal canal

Vaginal atrophy is not only uncomfortable and painful, but it can cause urinary issues too, such as:

• Burning with urination
• Urgency with urination
• Frequent urination

One woman’s experience

Today, a client told me she had experienced penetration, feeling like sandpaper being rubbed on the inside of her vagina with some bleeding following intercourse. I asked what had made her carry on making love rather than stopping; after all, there are many other ways to be intimate. Her response saddened me greatly. She said:

“I love my partner, and I love making love with him. I want to hold on to our love life; I don’t want him to think I’m broken.”

She had experienced this pain increased over the past few months and hadn’t known what to do or where to go for help. I’m glad she came to see me.

Take action, don’t suffer

This is a condition that no woman needs to suffer with. However, there are a few things that can be done to help ease vaginal atrophy, returning the enjoyment of lovemaking to the relationship:

• A menopause specialist will help with all the specific symptoms you have. They are usually able to prescribe vaginal lubricants with estrogen and advice you on how to use them. I have only heard positive feedback from women who have sought their advice.
• Over the counter, vaginal lubricants can help. They are available at a chemist or online; I noticed vaginal lubricants being available even on Amazon. The ones I recommend to my clients are either YES or Sylk. If you contact either via their online chat facility, they might offer you some free samples so you can try them before you buy.
• Your doctor will also be able to help, and some general practitioners have a menopause-trained nurse attached to the clinic. It’s worth asking.

It is worth taking a look at the menopause NICE Guidelines to gain insight into what you should expect from the care you are seeking. The NICE Guidelines were developed in 2015 while menopause training became available for nurses in the UK.

If you or your partner is suffering from vaginal atrophy, seek the available help. Your relationship need not be without intimacy, and you should be able to enjoy it as much as you ever have.

Making love as we get older

As we get older, we need to take it easy, slow lovemaking down and enjoy more touching, stroking, kissing of bodies, and holding³. Many couples of a certain age coming to psychosexual therapy have spent years rushing through the act of lovemaking resulting in one or both losing interest. That might be all we have time for when our children are young, and we are working at succeeding in our careers, but with age, our bodies tend to respond differently. We are no longer able to get the rush of excitement we used to.

Taking our time to be intimate together will give our bodies a chance to catch up with what we are doing. The added extra is that it becomes much more enjoyable too. Towards the end of psychosexual therapy, couples in this age group often report that they enjoy touching so much the intercourse is simply a plus rather than the aim.

Having an enjoyable sex life into very old age is the spice of life and will keep us truly alive for longer. Don’t let vaginal atrophy stop you from getting close, seek the help available, and magic can become a reality.

References and further reading

¹Vaginal Atrophy

²Vulvovaginal Atrophy

³Better Sex as You Age

The post Here is a Solution to Painful Sex appeared first on Medika Life.

If you haven’t yet gone through menopause, but find you are bothered with this condition, we’d advise a visit to your gynecologist who can check you over thoroughly. A drop in your estrogen levels can also lead to dryness, resulting from

• Childbirth and breastfeeding
• Radiation or chemotherapy treatment for cancer
• Surgical removal of the ovaries
• Anti-estrogen medications used to treat uterine fibroids or endometriosis

For most women, a lack of vaginal moisture will have a significant impact on their sex life and the pleasure they derive from the act. It can also affect your relationship with your partner or spouse. The great news is that sex does not have to hurt and today’s woman is spoilt for choice, with many alternatives to provide the vagina with moisture and restore the joys of intimacy.

Here are eight easy tips to help you solve the problem of vaginal dryness, but first a few things you should avoid that can aggravate vaginal dryness. Avoid using douches, bubble baths, scented soaps, and lotions around the sensitive vaginal area. These will contribute to vaginal dryness.

Natural Choices for Vaginal Dryness

None of the options below may appeal to you if you’re eager to keep things natural. There are easy solutions here too. You can use grapeseed, olive, sweet almond, sunflower, or coconut oil. If dryness is a problem, these oils are great lubricants that can be safely applied in and around your genitals for a more sensual love-making session. Coconut oil is particularly suited. Always select an organic certified oil when possible for this sensitive and highly absorbent part of your body.

1. Water-based sexual lubricants

Brands: Astroglide, Durex, KY and others

How they work: Sexual lubricants reduce friction. Lubricants enhance the experience and eliminate painful chafing and burning. The application of sexual lubricant as a part of foreplay is a simple trick for many women to improve sexual pleasure. Lube may be applied directly to the vagina, clitoris, or penis before penetration.

Some lubricants may affect sperm function, potentially decreasing the chances of a person getting pregnant, so those who are trying to conceive should choose a sperm-friendly lubricant. People hoping to prevent pregnancy and using lubricants can consider spermicides along with other contraceptives.

Not all lubricants are the same. Most lubricants available at a local pharmacy are water-based.

Pros: Water-based lubricants are the safest choice to prevent sexually transmitted infections. They do not break down latex in condoms or sex toys. Water-based lubricants are ideal for those with sensitive skin or those prone to vaginal irritation and s a final plus, water-based lubricants do not leave stains on sheets and are easy to clean in the laundry. 

Cons: Water-based lubricants dry out quickly. Rapid drying may require reapplication for longer sexual sessions. For those suffering from chronic vaginal dryness or inadequate natural lubrication during sex, they may be insufficient. Water-based lubricants are not always the best option for postmenopausal women.

2. Silicone-based sexual lubricants

Brands: Platinum Wet is a popular choice. This Paraben and Glycerin free product reduces the risk of chemical irritation. Penchant Premium is another hypoallergic option ideal for those with sensitive skin. 

Pros: Silicone-based lubricants stay slippery longer, avoiding the frustration of rapid drying and reapplication messiness. This type of lubricant does not evaporate when exposed to air and provides a wet sensation for longer sexual encounters. Since they are not water-based, silicone lubes may be used in the shower or bathtub as they’re resistant to water.

Silicone-based lubricants may be more effective and pleasurable for monogamous couples at low risk for sexually transmitted infections. 

Cons: Non-water-based lubricants also have downsides. They are messy. Soap and water must be used to remove them, and they will also stain your sheets and clothing. Also, you’ll need to watch your toys. Silicone-based lubricants break down latex, so condoms and sex toys need to be kept away.

3. Foreplay 

You can not underestimate the value of foreplay for those with chronic vaginal dryness. Foreplay gets the juices flowing by increasing sexual arousal. Blood flow to genitals increases, causing the vagina, labia, and clitoris to swell. 
Better stimulation leads to more natural lubrication and an increase in vaginal elasticity. The vagina then secretes natural lubrication, which increases pleasure and reduces pain. 
For those with chronic vaginal dryness, communicating sexual needs and desires to your partner is critical. Sexual partners may be unaware of the physiological changes and not know what to do. Providing feedback allows the partner to learn how best to meet your needs. You can even sit them down in front of this article as a great way to break the ice.

4. Vaginal Moisturizers

Brands: Popular products include Replens®, Lubrin®, Sylk®, vitamin E vaginal suppositories, Astroglide®, Luvena®, K-Y Jelly®

How they work: Multiple over-the-counter products are available to help increase vaginal moisture. Their effects usually last for several days. The basic idea is to prevent dryness and improve the vaginal ph balance. These products do not treat the underlying cause of vaginal dryness. They are useful for day-to-day use to alleviate discomfort and improve vaginal moisture and can be safely used alongside vaginal lubricants.

Those with sensitive skin may benefit from avoiding products containing parabens, glycerin, or propylene glycol. These additives may cause skin irritation. 

5. Vaginal Estrogen

Brands: Estring, Vagifem, Estrace, Premarin

Why: Estrogen is one of the most important female hormones. A decrease in the production of estrogen by the ovaries triggers physiological changes in the vagina. The vaginal tissues thin out, and lubrication decreases. Breastfeeding, certain medications, and menopause all cause estrogen deficiency.

How they Work: Prescription estrogen medication can be placed directly into the vagina to offset the deficiency. Low dose Estrogen applied directly to the vagina bulks up vaginal cells and increases blood flow. Restoring vaginal health allows cells to produce more moisture. Natural lubrication improves, and the more elastic vaginal walls reduce resistance to trauma during penetration.

You have three options with vaginal estrogen to combat vaginal dryness and all three will require a prescription and a visit to your healthcare provider

• Ring (Estring): You or your doctor inserts this soft, flexible ring into your vagina where it releases a steady stream of estrogen directly to the tissues. The ring is replaced every 3 months.
• Tablet (Vagifem): You use a disposable applicator to put a tablet into your vagina once a day for the first two weeks of treatment. Then you do it twice a week until you no longer need it.
• Cream (Estrace, Premarin): You use an applicator to get the cream into your vagina. You’ll typically apply the cream daily for 1 to 2 weeks, then cut back to one to three times a week as directed by your doctor.

Pros: Easy to use[

Cons: Not everyone can use these products. Side effects can include vaginal bleeding and breast pain.

6. DHEA supplements 

Brand: Only one medication is commercially available. Prasterone, sold under the brand name Intrarosa

The DHEA hormone is a highly effective alternative to estrogen therapy. Before menopause, DHEA levels are high. As the ovaries stop functioning, DHEA levels fall. DHEA supplements can be placed into the vagina to restore vaginal health, reduce intercourse pain, and improve vaginal dryness. 

Only one medication is commercially available. Prasterone, sold under the brand name Intrarosa, is a plant-derived form of DHEA. Prasterone is inserted into the vagina once a day through an easy to use applicator. DHEA converts into estrogen targeting the underlying cause of dryness. It is FDA indicated for painful intercourse.

Prasterone requires a prescription and monitoring by a health provider.

7. Selective Estrogen Receptor Modulators 

Brands: Ospemifene is the only FDA approved SERM for vaginal dryness and painful intercourse.

How they work: An important alternative to estrogen therapy is a class of drugs called SERMS (Selective Estrogen receptor modulators). These medications act directly on the hormone receptors. Direct targeting of the vaginal tissue increases the thickness of the superficial and parabasal vaginal cells.

Like estrogen and DHEA therapy, the restored health of the vaginal cells improves the natural ability to produce moisture and lubrication. 

Pros: For postmenopausal women, selective estrogen receptor modulators (SERMs) drugs act as partial estrogen receptors agonists for maintaining bone density and at the same time act as estrogen receptor antagonists in breast tissues for applications in breast cancer prevention in women, along with effects on the uterus and vagina that depend on their interaction with the estrogen receptors in target tissues.

Cons: Ospemifene requires a prescription and monitoring by a health provider.

8. Topical Sildenafil 

Sildenafil is a popular medication used to treat erectile dysfunction in men by increasing blood flow to the penis. Some women benefit from the topical application of Sildenafil. 

A pea-size amount of compounded Sildenafil cream is applied directly to the clitoris before intercourse. Sildenafil cream increases blood flow to the clitoris. For some women, the increased blood flow triggers more natural lubrication, improves pleasure, and helps to achieve orgasm. 

Sildenafil requires a prescription and monitoring by a health provider for this off-label use.

Vaginal dryness is a problem that is easily overcome

Vaginal dryness is a common symptom among women. Painful intercourse and vaginal discomfort are easily overcome and shouldn’t be allowed to impact your quality of life. The options above can help you safely restore vaginal health and enhance your sexual experience. 

The post Beat Vaginal Dryness and Painful Intercourse. 8 Tips for Better Lubrication appeared first on Medika Life.

What is douching?

The word “douche” means to wash or soak. Douching is washing or cleaning out the inside of the vagina with water or other mixtures of fluids. Most douches are sold in stores as prepackaged mixes of water and vinegar, baking soda, or iodine. The mixtures usually come in a bottle or bag. You squirt the douche upward through a tube or nozzle into your vagina. The water mixture then comes back out through your vagina.

Douching is different from washing the outside of your vagina during a bath or shower. Rinsing the outside of your vagina with warm water will not harm your vagina. But, douching can lead to many different health problems.

Most doctors recommend that women do not douche.

How common is douching?

In the United States, almost one in five women 15 to 44 years old douche.

More African-American and Hispanic women douche than white women. Douching is also common in teens of all races and ethnicities.

Studies have not found any health benefit to douching. But, studies have found that douching is linked to many health problems.

Why should women not douche?

Most doctors recommend that women do not douche. Douching can change the necessary balance of vaginal flora (bacteria that live in the vagina) and natural acidity in a healthy vagina.

A healthy vagina has good and harmful bacteria. The balance of bacteria helps maintain an acidic environment. The acidic environment protects the vagina from infections or irritation.

Douching can cause an overgrowth of harmful bacteria. This can lead to a yeast infection or bacterial vaginosis. If you already have a vaginal infection, douching can push the bacteria causing the infection up into the uterus, fallopian tubes, and ovaries. This can lead to pelvic inflammatory disease, a serious health problem.

Douching is also linked to other health problems.

What health problems are linked to douching?

Health problems linked to douching include:⁵

• Bacterial vaginosis (BV), which is an infection in the vagina. Women who douche often (once a week) are five times more likely to develop BV than women who do not douche.
• Pelvic inflammatory disease, an infection in the reproductive organs that is often caused by an STI
• Problems during pregnancy, including preterm birth and ectopic pregnancy
• STIs, including HIV
• Vaginal irritation or dryness

Researchers are studying whether douching causes these problems or whether women at higher risk for these health problems are more likely to douche.

Should I douche to get rid of vaginal odor or other problems?

No. You should not douche to try to get rid of vaginal odor or other vaginal problems like discharge, pain, itching, or burning.

Douching will only cover up odor for a short time and will make other problems worse. Call your doctor or nurse if you have:

• Vaginal discharge that smells bad
• Vaginal itching and thick, white, or yellowish-green discharge with or without an odor
• Burning, redness, and swelling in or around the vagina
• Pain when urinating
• Pain or discomfort during sex

These may be signs of a vaginal infection, or an STI. Do not douche before seeing your doctor or nurse. This can make it hard for the doctor or nurse to find out what may be wrong.

Should I douche to clean inside my vagina?

No. Doctors recommend that women do not douche. You do not need to douche to clean your vagina. Your body naturally flushes out and cleans your vagina. Any strong odor or irritation usually means something is wrong.

Douching also can raise your chances of a vaginal infection or an STI. If you have questions or concerns, talk to your doctor.

What is the best way to clean my vagina?

It is best to let your vagina clean itself. The vagina cleans itself naturally by making mucous. The mucous washes away blood, semen, and vaginal discharge.

If you are worried about vaginal odor, talk to your doctor or nurse. But you should know that even healthy, clean vaginas have a mild odor that changes throughout the day. Physical activity also can give your vagina a stronger, muskier scent, but this is still normal.

Keep your vagina clean and healthy by:

• Washing the outside of your vagina with warm water when you bathe. Some women also use mild soaps. But, if you have sensitive skin or any current vaginal infections, even mild soaps can cause dryness and irritation.
• Avoiding scented tampons, pads, powders, and sprays. These products may increase your chances of getting a vaginal infection.

Can douching before or after sex prevent STIs?

No. Douching before or after sex does not prevent STIs. In fact, douching removes some of the normal bacteria in the vagina that protect you from infection. This can actually increase your risk of getting STIs, including HIV, the virus that causes AIDS. 

Should I douche if I had sex without using protection or if the condom broke?

No. Douching removes some of the normal bacteria in the vagina that protect you from infection. This can increase your risk of getting STIs, including HIV. Douching also does not protect against pregnancy.

If you had sex without using protection or if the condom broke during sex, see a doctor right away. You can get medicine to help prevent HIV and unwanted pregnancy.

Should I douche if I was sexually assaulted?

No, you should not douche, bathe, or shower. As hard as it may be to not wash up, you may wash away important evidence if you do. Douching may also increase your risk of getting STIs, including HIV. Go to the nearest hospital emergency room as soon as possible. The National Sexual Assault Hotline at 800-656-HOPE (4673) can help you find a hospital able to collect evidence of sexual assault. Your doctor or nurse can help you get medicine to help prevent HIV and unwanted pregnancy.

Can douching after sex prevent pregnancy?

No. Douching does not prevent pregnancy. It should never be used for birth control. If you had sex without using birth control or if your birth control method did not work correctly (failed), you can use emergency contraception to keep from getting pregnant.

If you need birth control, talk to your doctor or nurse about which type of birth control method is best for you.

How does douching affect pregnancy?

Douching can make it harder to get pregnant and can cause problems during pregnancy:

• Trouble getting pregnant. Women who douched at least once a month had a harder time getting pregnant than those women who did not douche.
• Higher risk of ectopic pregnancy. Douching may increase a woman’s chance of damaged fallopian tubes and ectopic pregnancy. Ectopic pregnancy is when the fertilized egg attaches to the inside of the fallopian tube instead of the uterus. If left untreated, ectopic pregnancy can be life-threatening. It can also make it hard for a woman to get pregnant in the future.
• Higher risk of early childbirth. Douching raises your risk for premature birth. One study found that women who douched during pregnancy were more likely to deliver their babies early. This raises the risk for health problems for you and your baby.

The post The Truth about Douching appeared first on Medika Life.

What is menopause?

We define menopause as when the menstrual cycle stops permanently. Ovulation has stopped and one can no longer get pregnant. You have reached menopause only after it has been a full year since your last period. This means you have not had any bleeding, including spotting, for 12 months.

After menopause, the ovaries make very low levels of the hormones estrogen and progesterone. The low hormone levels trigger menopausal symptoms and can raise your risk for certain health problems. 

What is perimenopause?

Perimenopause means “around menopause.” These years are the menopausal transition time leading up to your last period.

Perimenopause is a long transition to menopause. The ovaries begin working “part-time” before they retire. During this time, the ovarian hormonal production may fluctuate at random, causing menopause symptoms unexpectedly. 

The alterations in estrogen and progesterone disrupt ovulation and trigger irregular periods. Some have longer periods and others shorter. Some may skip a few months. When the cycle comes it may be lighter or heavier than before. Many women also have hot flashes and other menopause symptoms during this transition.

Hot flashes and night sweats are two of the most common and frustrating menopausal symptoms. A hot flash is a sudden sense of intense internal heat sometimes accompanied by sweating, a rapid heartbeat, and facial redness.

When does the transition to menopause usually start?

Perimenopause, the transition to menopause, usually starts in a woman’s mid- to late 40s. On average, women are in perimenopause for four years before their periods stop.

How will I know if I am starting the transition to menopause?

Sometimes it can be hard for you and your doctor to tell whether you are in perimenopause, the transition to menopause:

• Symptoms: Tell your doctor or nurse about any menopause symptoms, such as hot flashes or trouble sleeping.
• Irregular periods: Track your periods. Irregular periods may be your first sign of menopause.
• Hormone levels: One hormone called FSH may be tested to help determine menopausal status. Your doctor may test other hormones levels if your periods stopped at an early age. Most doctors do not routinely check estrogen and progesterone levels without a medical reason because the hormones fluctuate unpredictably making interpretation of the results challenging.

How will menopause affect me?

Each woman experiences menopause differently. Menopausal symptoms may begin suddenly and be very noticeable, or they may be very mild at first. Symptoms may happen most of the time or sporadically. Some women notice changes in many areas. Some menopausal symptoms, such as moodiness, are similar to symptoms of premenstrual syndrome (PMS). Others may be new to you. For example:

• Your menstrual periods may not come as regularly as before. They also might last longer or be shorter. You might skip some months. Periods might stop for a few months and then start up again.
• Your periods might be heavier or lighter than before.
• You might have hot flashes and problems sleeping.
• You might experience mood swings or be irritable.
• You might experience vaginal dryness causing pain or discomfort during sex.
• You may have less interest in sex. It may take longer for you to get aroused.

Other possible changes are not as noticeable. For example, low estrogen levels cause a reduction in bone density. This can lead to osteoporosis, a condition that causes bones to become weak and break easily. Decreasing estrogen levels can also raise cholesterol levels increasing the risk of heart disease and stroke.

Many women choose to fight through menopausal symptoms while others choose hormonal supplementation to alleviate bothersome symptoms.

How long does the transition to menopause last?

Perimenopause can last between two and eight years before your menstrual cycles stop completely. For most women, this transition to menopause lasts about four years. Menopause has officially started when it has been twelve months from the last period.

Should I continue using birth control during the transition to menopause?

Yes. You can still get pregnant during perimenopause. While the ovaries are no longer working full-time ovulation can still occur. If the ovaries release an egg then pregnancy may be possible.

It is impossible to know for sure when you will ovulate during this transition. If you don’t want to get pregnant, you should continue to use birth control until one full year after your last period. Talk to your doctor about your contraceptive needs.

You can’t get pregnant after menopause, but anyone who has sex is at potential risk for sexually transmitted infections (STIs). If you are not in a monogamous relationship in which you and your partner have sex with each other and no one else, protect yourself by using a male condom or dental dam correctly every time you have vaginal, oral, or anal sex. After menopause, you may be more likely to get an STI from sex without a condom. Vaginal dryness can cause small cuts or tears during sex, exposing you to STIs.

When does menopause usually happen?

The average age of menopause in the United States is 52. The range for women is usually between 45 and 58. 

Menopause may happen earlier if you:

• Never had children. Pregnancy, especially more than one pregnancy, may delay menopause.
• Smoke. Studies show smoking can cause you to start menopause up to two years earlier than women who don’t smoke.

Certain health problems can also cause you to start menopause earlier.

Menopause usually happens on its own. However, you may enter menopause earlier than you normally would if you have had chemotherapy or surgery to remove both ovaries. Learn more about early menopause on our early or premature menopause page. 

What happens after menopause?

After menopause, you will no longer be able to get pregnant and you will no longer get a period. If you have any type of vaginal bleeding after menopause, you should see a doctor as soon as possible. Vaginal bleeding after menopause is not normal and can indicate a serious health problem.  

You may experience any of the following after menopause:

• Low hormone levels. With menopause, your ovaries make very little of the hormones estrogen and progesterone. Because of changing hormone levels, you may develop certain health risks, including osteoporosis, heart disease, and stroke.
• Menopausal symptoms instead of period problems. During menopause, most women trade period problems for menopause symptoms. As one passes through menopause, occasional hot flashes and sleep disturbances may persist.
• Vaginal dryness. Our bodies change as we grow older, but we do not have to age without a fight. Vaginal dryness is a common condition affecting 50–70% of women after menopause. A lack of lubrication is the most common cause of dyspareunia (dis-puh-ROO-nee-uh) or painful intercourse.

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